Provider Demographics
NPI:1992210231
Name:CS MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:CS MEDICAL ASSOCIATES, PC
Other - Org Name:VICTORY RECOVERY PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAOLO
Authorized Official - Middle Name:
Authorized Official - Last Name:COPPOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-696-4357
Mailing Address - Street 1:100 GRANNY RD STE 1
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2879
Mailing Address - Country:US
Mailing Address - Phone:631-696-4357
Mailing Address - Fax:631-846-8138
Practice Address - Street 1:100 GRANNY ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738
Practice Address - Country:US
Practice Address - Phone:631-696-4357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-08
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207QA0401X
261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty